NPIMap

Organization Active NPI

Spencer Municipal Hospital

Doing business as Warner Dialysis Center Spencer

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Spencer, IA
National Provider Identifier
1578550893
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
37H Issued in IA
Legal business name
SPENCER MUNICIPAL HOSPITAL
Doing business as
Warner Dialysis Center Spencer
Practice address
1721 W 18TH St
Spencer, IA 51301-2827
Phone
(712) 264-6611
Fax
(712) 264-6614
NPI assigned
Oct 3, 2005
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brenda Tiefenthaler
Title
Chief Executive Officer
Phone
(712) 264-6111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 37H IA Primary

Addresses

Primary practice location

1721 W 18TH St
Spencer, IA 51301-2827

Mailing address

1200 1St Ave E
Spencer, IA 51301-4330
Phone (712) 264-6111

Other identifiers 1

IdentifierTypeStateIssuer
0601120MedicaidIA

Other names 1

  • Warner Dialysis Center Spencer Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181119002420 IA Part A Provider - End-Stage Renal Disease Facility (ESRD) 4183533060 Practice locations: Spencer, IA

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Warner Dialysis Center SpencerCCN 163516
Overall star rating
4.0 of 5
Ownership
Non-profit
Certified
Oct 17, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
14

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1578550893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 1ST AVE E",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513014330",
            "telephone_number": "712-264-6111",
            "fax_number": "712-264-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 W 18TH ST",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513012827",
            "telephone_number": "712-264-6611",
            "fax_number": "712-264-6614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER MUNICIPAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "TIEFENTHALER",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "712-264-6111"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "IA",
            "license": "37H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0601120",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warner Dialysis Center Spencer",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Warner Dialysis Center Spencer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spencer, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.